Table of Content

10 July 2025, Volume 33 Issue 7

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Professional Forum

Impact of parent-child attachment on children′s emotional development: Challenges and strategies in the digital era

LIU Qiaoyun

2025, 33(7):  697-701.  DOI: 10.11852/zgetbjzz2025-0662

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Parent-child attachment serves as the cornerstone of children′s emotional development.Parent-child attachment encompasses secure, avoidant, ambivalent, and disorganized types.Both attachment styles and age exert influences on children′s emotional growth, affective understanding, and regulation.In the digital era, phenomena such as "technoference", "excessive screen exposure" , and "behavioral modeling-enhanced control" pose significant threats to the formation of secure parent-child attachment, thereby impacting children′s emotional development.This paper proposes the STEP strategy, which includes Selecting appropriate digital content, engaging Together in digital product usage, Engineering well-designed timing and contexts for digital use, and Promoting parents′ interactive competencies scientifically.This framework aims to facilitate the scientific transition of parent-child attachment into the digital age and foster healthy emotional development in children.

Qriginal Articles

Preliminary study of the cognitive and behavioral characteristics of autism spectrum disorder children with savant skills

WANG Yu, LI Yan, ZHU Huilin, CAO Wei, ZOU Xiaobing

2025, 33(7):  702-706.  DOI: 10.11852/zgetbjzz2024-0651

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Objective To explore the cognitive and behavioral characteristics of children with autism spectrum disorder (ASD) who possess savant skills (ASD-SS) aged 4 - 15 years, in order to further understand the heterogeneity within the ASD population and provide a scientific basis for better identification and tailored educational and intervention support. Methods From June 2018 to August 2019, ASD children aged 4 - 15 years were recruited from the Child Development Behavior Center of the Third Affiliated Hospital of Sun Yat-sen University and through community recruitment. Based on skill screening and parental interviews, 30 children with savant skills (ASD-SS group) and 26 children without savant skills (ASD-NSS group) were selected. Cognitive assessments were conducted using the Wechsler Intelligence Scale and the Empathy/Systemizing Quotient (EQ-SQ) scale, while behavioral assessments were performed using the Autism Diagnostic Observation Schedule (ADOS) and the Repetitive Behavior Scale (RBS). SPSS 20.0 was used to compare the cognitive and behavioral characteristics between the two groups. Results 1) Cognitive characteristics: Compared to the ASD-NSS group, the ASD-SS group exhibited significantly lower empathy quotients (t=3.59, P<0.05), higher systemizing quotients (t=3.29, P<0.05), and a greater difference between empathy and systemizing quotients (t=5.02, P<0.05). While there was no significant difference in general intelligence levels between the two groups (P>0.05), the ASD-SS group scored significantly higher in the block design task (t=2.42, P<0.05). 2) Behavioral characteristics: In terms of restricted and repetitive behaviors, the ASD-SS group showed significantly higher levels of restricted interests compared to the ASD-NSS group (Z=2.696, P<0.01), while no significant differences were observed in stereotyped, self-injurious, compulsive, or ritualistic behaviors (P>0.05). Regarding social communication behaviors, there was no significant difference in the severity of social communication abnormalities between the two groups (P>0.05). Conclusions Among children aged 4 - 15 years with ASD, those with savant skills demonstrate superior perceptual reasoning abilities, higher systemizing tendencies, and lower empathy levels in cognitive domains. Behaviorally, they exhibit more pronounced restricted interests.

Mendelian randomization analysis on the association between gut microbiota and attention deficit/hyperactivity disorder with autism spectrum disorder

JIANG Hanxiao, QIAO Yi, QU Yanlin

2025, 33(7):  707-714.  DOI: 10.11852/zgetbjzz2024-1270

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Objective To analyze the potential causal relationship between gut microbiota (GM) and two common neurodevelepmentcoldisorders, attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) using Mendelian randomization (MR). Methods A two-sample MR analysis was conducted using publicly available genome-wide association study (GWAS) data to explore the relationship between gut microbiota and ADHD/ASD. Independent genetic loci significantly associated with the relative abundance of 211 gut microbiota taxa were selected as instrumental variables (IVs) based on a predefined threshold (P<10^-5). Multiple methods, including the inverse-variance weighted (IVW) method, were employed for analysis, with results evaluated using odds ratios (ORs) and 95% confidence intervals (CIs). Sensitivity analysis, including leave-one-out analysis, heterogeneity testing, and horizontal pleiotropy testing, were performed to ensure the stability and reliability of the results. Results Increased abundance of Desulfovibrio (OR=0.742, 95%CI: 0.595 - 0.925), Porphyromonadaceae (OR＝0.761, 95%CI: 0.585 - 0.989), and Firmicutes (OR＝0.799, 95%CI: 0.646 - 0.988) was associated with a reduced risk of ADHD. In contrast, increased abundance of Bifidobacteriales was identified as a potential risk factor for ADHD (OR＝1.335, 95%CI: 1.111 - 1.605). For ASD, increased abundance of Ruminococcus (OR＝0.778, 95%CI: 0.671 - 0.901), Gram-negative bacillus (OR＝0.821, 95% CI: 0.684 - 0.987), and Gram-positive anaerobic bacteria (OR＝0.811, 95%CI: 0.686 - 0.959) was associated with a reduced risk, while increased abundance of Prevotella was associated with an increased risk of ASD (OR＝1.238, 95%CI: 1.091 - 1.404). Leave-one-out analysis confirmed the stability of the results, with no strong influential IVs detected. Heterogeneity and horizontal pleiotropy were ruled out as confounding factors. Conclusions This study demonstrates a potential causal link between gut microbiota and two common childhood psychiatric disorders, ADHD and ASD. It provides valuable insights into specific microbial taxa that may influence disease risk, offering a foundation for further research and potential therapeutic targets.

Characteristics of non-suicidal self-injury in children and adolescents with anxiety and depressive disorders

SUN Yang, HUANG Yanhuan, SUN Haiming, YU Xinming, NI Hua, ZHANG Xiaochen, LI Ling, CHENG Wenhong, LIU Wenjing

2025, 33(7):  715-720.  DOI: 10.11852/zgetbjzz2024-0244

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Objective To explore the characteristics of non-suicidal self-injury (NSSI) behaviors in children and adolescents with anxiety disorders and depressive disorders, in order to provide a theoretical basis for clinical interventions. Methods From October 2019 to October 2023, 135 subjects were investigated through convenience sampling method from the Child and Adolescent Psychological Counseling Clinic at the Shanghai Mental Health Center between October 2019 and October 2023.The Ottawa Self-Injury Questionnaire was used to measure self-injury methods and motivations.The Children′s Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, the Parental Bonding Instrument, the Childhood Trauma Questionnaire, and the Coping Style Questionnaire for Middle School Students were employed to assess levels of anxiety and depression, parenting environment, and coping characteristics.Independent sample t-tests and chi-square tests were used to compare differences between the two groups. Results A total of 135 participants aged 9 to 17 were included, with 37 having anxiety disorders accompanied by NSSI and 98 having depressive disorders accompanied by NSSI.Compared to the anxiety disorder group, the depressive disorder group with NSSI exhibited more detection rates of self-injury on the arms (χ²=4.22, P=0.04).The rate of cutting as a method of self-injury was significantly higher in the depressive disorder group with NSSI than in the anxiety disorder group (χ²=4.92, P=0.03), while nail-biting was significantly more common in the anxiety disorder group with NSSI than in the depressive disorder group with NSSI (χ²=5.11, P=0.02).Compared to the anxiety disorder group with NSSI, the depressive disorder group with NSSI had a higher motivation for sensation-seeking (P<0.05).The depressive disorder group with NSSI also experienced more emotional neglect/abuse and physical neglect/abuse during childhood, felt less emotional warmth from both parents, and used problem-solving coping strategies less frequently (P<0.05). Conclusions Children and adolescents with anxiety disorders and depressive disorders accompanied by NSSI exhibit different characteristics in terms of self-injury locations and motivations.Therefore, targeted intervention plans should be designed.

Association of maternal weight gain during pregnancy, pre-pregnancy body mass index, and their combined effect with emotional and behavioral problems in preschool children

LIU Meng, HUANG Jia, XU Xiaojing, LU Qingyun, WANG Yafei, LI Yan

2025, 33(7):  721-728.  DOI: 10.11852/zgetbjzz2024-0989

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Objective To investigate emotional and behavioral problems in preschool children in Nantong City, and to analyze the relationship between maternal gestational weight gain (GWG), pre-pregnancy body mass index (BMI), and their combined effects on children′s emotional and behavioral problems, so as to provide evidence for health management during and before pregnancy. Methods A cross-sectional survey was conducted in eight kindergartens in Nantong City from September to December 2023, involving 2 176 preschool children. Maternal GWG and pre-pregnancy BMI were obtained through questionnaires, and children′s emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Multivariate Logistic regression models were used for data analysis. Results The abnormal detection rates of preschool children in peer relationship problems, hyperactivity, prosocial behavior, conduct problems, and emotional symptoms were 30.33％(660/2 176)、29.60％(644/2 176)、26.01％(566/2 176)、22.62％(492/2 176), and 18.00％(392/2 176), respectively, with an overall abnormal detection rate of 23.90%(521/2 176). Boys had a higher abnormal detection rate than girls(χ²=94.732, P＜0.01). Maternal pre-pregnancy overweight/obesity and excessive GWG were identified as risk factors for emotional and behavioral problems in preschool children (OR＝1.19, 95%CI: 1.01 - 1.31,P<0.05; OR＝1.12, 95%CI: 1.03 - 1.22,P<0.05). Stratified by pre-pregnancy BMI, excessive GWG was an independent risk factor for emotional and behavioral problems in children across normal-weight, underweight, and overweight/obese groups (OR＝1.09, 95%CI: 1.03 - 1.43,P<0.05; OR＝1.37, 95%CI: 1.02 - 1.89,P<0.05; OR＝1.35, 95%CI: 1.07 - 1.71,P<0.05). The combined effects of insufficient GWG with pre-pregnancy overweight/obesity, excessive GWG with pre-pregnancy underweight, and normal pre-pregnancy BMI significantly increased the risk of emotional and behavioral problems in offspring (OR=1.30,95%CI: 1.15 - 1.56,P<0.05; OR= 1.20, 95%CI: 1.02 - 1.46,P<0.05; OR＝1.10, 95%CI: 1.02 - 1.23,P<0.05). Gender-stratified analysis revealed that insufficient GWG combined with pre-pregnancy overweight/obesity was a risk factor for emotional and behavioral problems in boys. Conclusions Maternal insufficient or excessive GWG and abnormal pre-pregnancy BMI are significantly associated with emotional and behavioral problems in preschool children, especially in boys. The combined effects of insufficient GWG and pre-pregnancy overweight/obesity have a pronounced impact on emotional and behavioral problems.

Prevalence of overweight/obesity in children with autism spectrum disorder and its correlation with emotional and behavioral problems

WANG Feiying, QIN Hongchao, TAO Xiaodong, QU Qiuchan, NI Yong, XU Zhanbin

2025, 33(7):  729-732.  DOI: 10.11852/zgetbjzz2024-1034

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Objective To investigate the prevalence of overweight/obesity in children aged 3 - 6 years with autism spectrum disorder (ASD),and to explore the correlation between overweight/obesity and emotional-behavioral problems, in order to provide a reference for developing comprehensive intervention strategies for ASD children. Methods From December 2022 to December 2023, 241 ASD children aged 3 - 6 years receiving rehabilitation training at designated rehabilitation institutions in Nantong City were enrolled as study subjects. Physical measurements and evaluations were conducted, and the Strengths and Difficulties Questionnaire (SDQ) was used to assess emotional-behavioral problems. The correlation between overweight/obesity and emotional-behavioral problems was analyzed. Results Among the 241 ASD children, 88 (36.51%) were overweight or obese, including 32 (13.28%) overweight and 56 (23.24%) obese cases. There was no statistically significant difference in the prevalence of overweight/obesity between genders (χ²=0.348, P>0.05). The abnormal rates of SDQ emotional symptoms and total difficulties score in the overweight/obese group were 11.36% and 82.95%, respectively, significantly higher than those in the normal-weight group (4.58% and 70.59%) (χ²=3.927, 4.569, P<0.05). Multiple linear regression analysis showed that BMI in ASD children was positively correlated with emotional symptoms and total difficulties score (P<0.01), and age was positively correlated with the total difficulties score (P<0.01). Conclusions Overweight/obesity is prevalent among ASD children and is positively correlated with emotional-behavioral problems. This highlights the need for relevant departments and parents of ASD children to emphasize scientific feeding practices, regularly monitor physical growth and emotional-behavioral issues, especially in older children, and advocate for early comprehensive interventions to actively improve prognosis.

Chain mediating role of anxiety and depression in the relationship between paternal involvement and problem behaviors of rural children

ZHANG Yuanqing, ZHANG Liansheng

2025, 33(7):  733-737.  DOI: 10.11852/zgetbjzz2024-1271

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Objective To explore the role of anxiety and depression in the relationship between paternal involvement and problem behaviors among rural children, so as to provide a theoretical basis for reducing problem behaviors in this population. Methods Data were derived from the Rural Children′s Mental Health Dataset, collected between March and May 2021. The dataset included responses from 16 primary schools across 7 provinces in China, using the Adolescent Evaluation of Paternal Involvement Questionnaire (Father Version), the Generalized Anxiety Disorder Scale, the Children′s Depression Inventory, and the Child Behavior Problem Scale. A total of 2 498 valid questionnaires were collected from rural children. This study focused on 825 rural children in the fifth and sixth grades. Pearson correlation analysis was employed to examine the relationships among the variables, and the SPSS PROCESS V4.2 macro was used for Bootstrap analysis and chain mediation effect testing. Results Among the 825 rural children, 368 (44.6%) exhibited no anxiety, 256 (31.0%) had mild anxiety, 154 (18.7%) had moderate anxiety, and 47 (5.7%) had severe anxiety. Additionally, 213 children (25.8%) were found to be at a risk of depression. Correlation analysis revealed that paternal involvement was significantly negatively correlated with rural children′s problem behaviors, anxiety, and depression (r＝-0.213,-0.204,-0.391, P<0.01). Problem behaviors were significantly positively correlated with anxiety and depression (r＝0.353, 0.402, P<0.01), and anxiety was significantly positively correlated with depression (r＝0.682, P<0.01). Mediation analysis indicated that the total effect of paternal involvement on problem behaviors was significant (β＝-0.213, P<0.05), as was the direct effect (β＝-0.089, P<0.05). The indirect effect of paternal involvement on problem behaviors, mediated by anxiety and depression, was also significant (β＝-0.124, P<0.05). The chain mediation effect of anxiety and depression accounted for 14.55% of the total effect. Conclusion Increasing paternal involvement can reduce problem behaviors in rural children, with anxiety and depression serving as chain mediators in the relationship between paternal involvement and problem behaviors.

Exploration of the feasibility and safety of virtual reality intervention for children and adolescents with autism spectrum disorder

YAN Wenjie, ZHAI Tianyu, LI Yan, JIANG Wenqing, CHEN Jing, SUN Zhixin, LIN Yuxiong, ZHANG Xiyan, DU Yasong

2025, 33(7):  738-742.  DOI: 10.11852/zgetbjzz2024-1154

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Objective To evaluate the feasibility, acceptability, safety, and effectiveness of immersive virtual reality (IVR) interventions in improving adaptive skills in children and adolescents with autism spectrum disorder (ASD). Methods From September 2023 to August 2024, 33 ASD participants aged 8 - 16 years were recruited to undergo an IVR intervention lasting an average of 8 weeks, with one session per week and each session lasting 1 hour. Assessments were conducted using questionnaires, interviews, and task completion time. Results Finally 84.8% of participants completed the intervention. In terms of acceptability, 100% of participants and their guardians were satisfied with the intervention setup and found the content engaging. The Presence Questionnaire (IPQ) results showed that the total score after the first intervention was within an acceptable range (0.41±0.85), but it significantly decreased to 0.26±0.98 after the final intervention(t=-2.150, P=0.041). Regarding safety, 39.4% of participants and 33.3% of guardians reported mild discomfort, primarily dizziness. The Simulator Sickness Questionnaire (SSQ) total score after the first intervention was within an acceptable range (19.77±12.07), and it was 17.36±13.11 after the final intervention, with no statistically significant difference (t=1.060, P=0.298). In terms of effectiveness, the total score of the self-designed daily living skills questionnaire significantly improved (t=3.788, P=0.001), and the completion times for IVR tasks across various scenarios significantly decreased. Conclusions The IVR system is safe, feasible, and effective for children and adolescents with ASD. Future studies should include control groups, expand the participant pool, incorporate more Objective assessments, and optimize the system to reduce motion sickness and enhance usability.

Basic Experimental Articles

Effects of fructo-oligosaccharides and galacto-oligosaccharides dietson the autism-like behaviors and gastrointestinal dysfunction of rat offspring induced by maternal immune activation

YANG Xiao, LIU Lingfei, LI Shuang, SHEN Wenbin, GU Huaiting

2025, 33(7):  743-749.  DOI: 10.11852/zgetbjzz2024-0585

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Objective To investigate the intervention effects of fructo-oligosaccharides (FOS) and galacto-oligosaccharides (GOS) diets on the behaviors and gastrointestinal dysfunction of rat model of autism spectrum disorder (ASD) induced by maternal immune activation (MIA), in order to provide a new approach for ASD intervention therapy based on intestinal function improvement. Methods Twenty-four Wistar pregnant rats were randomly divided into a MIA model group and a control (NS) group. On gestational day 15 (GD15), pregnant rats in the MIA group were intraperitoneally injected with 10mg/kg of Poly(I∶C), while those in the control group were injected with the same volume of 0.9% sterile saline. Three hours later, blood was collected from the live heart, and the levels of interleukin-6 (IL-6), interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α) were measured by ELISA. Male offspring were randomly divided into four groups: model group-regular diet (MIA-Con), model group-prebiotic diet (MIA-Fos+Gos), control group-regular diet (NS-Con), and control group-prebiotic diet (NS-Fos+Gos). Rats in the MIA-Fos+Gos and NS-Fos+Gos groups were fed with customized FOS+GOS diets starting from weaning at 3 weeks of age for 5 consecutive weeks. After the intervention, behavioral tests including the open field test, three-chamber social interaction test, marble burying test, and grooming test, as well as gastrointestinal function assessments such as fecal water content and small intestinal transit rate, were conducted. Results Compared with the NS group, the levels of IL-6, IFN-γ, and TNF-α in the serum of pregnant rats in the MIA group significantly increased (t=2.390, 2.525, 2.305, P<0.05), indicating an immune-activated state. Compared with the NS-Con group, rats in the MIA-Con group exhibited significantly decreased total movement distance and number of crossed grid lines in the center zone during the open field test, reduced social ability index and social preference index, increased number of buried marbles, and prolonged grooming time(P<0.05). Additionally, the fecal water content and small intestinal transit rate increased in the MIA-Con group (P<0.05). After the intervention of FOS+GOS diet, compared with the MIA-Con group, rats in the MIA-Fos+Gos group showed that the total movement distance in the open field test of increased, the social ability index and social preference index improved, the number of buried marbles decreased, and the grooming time shortened (P<0.05). Furthermore, the fecal water content and small intestinal propulsion rate decreased in the MIA-Fos+Gos group (P<0.05). Conclusion The FOS+GOS diet could attenuate social deficits, anxiety and stereotypical behaviors, and gastrointestinal dysfunction of male offspring which induced by MIA.

Review

Negative emotional attention bias in children

YANG Zihan, DENG Yujiao, LIU Jieqiong, WANG Guanghai, JIANG Fan

2025, 33(7):  750-754.  DOI: 10.11852/zgetbjzz2024-0098

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Mental health problems in children constitute great challenge for children′s primary care in China. Negative emotional attention bias is considered as an important early risk factor. Negative emotional attention bias has been observed in infants with development throughout the childhood, influenced by several internal and external factors. This article focuses on the developmental patterns of negative emotion attention bias during childhood and its key influencing factors, providing references for early prevention and intervention of child mental health problems.

Research progress on emotional dysregulation in childrenwith autism spectrum disorder abroad

JIN Shaoju, LI Yan, XU Sheng

2025, 33(7):  755-759.  DOI: 10.11852/zgetbjzz2024-0233

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Emotional dysregulation (ED) is an important clinical feature of children with autism spectrum disorder (ASD), which severely affects their social integration and daily life. This article systematically reviews the research progress of relevant literature on the clinical characteristics, etiological characteristics, clinical evaluation and intervention of ED in children with ASD abroad, in order to provide practical basis for the evaluation and intervention of ED in children with ASD in China.

Efficacy of parent-involved cognitive behavioral therapy for anxiety disorders

SU Manyi, MA Changminghao, CHENG Wenhong

2025, 33(7):  760-764.  DOI: 10.11852/zgetbjzz2024-0540

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This article provides an overview and summary of the application and key influencing factors of parental involvement in cognitive behavioral therapy (CBT) for the treatment of anxiety disorders in children and adolescents. It emphasizes the critical role of parents in therapy and provides a detailed analysis of methods, effectiveness, and feasibility of parent-focused interventions based on CBT. The paper explores the importance of key factors such as parental anxiety management, emotional support, reducing accommodating behaviors, shifting control, and enhancing parental involvement. These findings deepen the understanding of the role of parents in the treatment of child and adolescent anxiety and provide directions for future research and clinical practice.

Application of ecological momentary assessment in the study of dynamic relationships between adolescent self-injury and related factors

HUANG Yanhuan, LIU Zhen, LIU Wenjing, NI Hua, CHENG Wenhong

2025, 33(7):  765-770.  DOI: 10.11852/zgetbjzz2024-0499

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Adolescent self-injurious behavior has garnered widespread mental health concern. Ecological momentary assessment (EMA) offer a novel perspective for deeply understanding the complexity and dynamics of individual self-harm among adolescents by providing real-time monitoring of the continuous changes in self-harm ideation and behaviors, as well as their interactions with psychosocial factors within natural settings. This article outlines the application of EMA in exploring patterns of self-harm behavior and the dynamic relationships of self-injurious behavior with self-harm functions, emotional states, coping strategies and interpersonal relationships.

Evidence of the application of the circle of security intervention in improving the mental health of parents and children

GONG Weiping, LI Jing

2025, 33(7):  771-777.  DOI: 10.11852/zgetbjzz2024-0541

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The circle of security (COS) intervention, based on attachment theory, has been widely applied across different cultures and populations globally, achieving remarkable results. By enhancing caregivers′ sensitivity and responsiveness to children′s emotional needs, the COS intervention not only improves the relationship between children and caregivers, strengthens children′s attachment security, socio-emotional functioning, and behavioral regulation abilities, but also significantly increases caregivers′ sensitivity, reduces their stress levels, improves their emotional regulation abilities, and enhances their self-efficacy and reflective capacity.The evidence suggests that when adapted for specific cultural contexts—specifically within China, considering its mental health needs—localized COS interventions can play a vital role in fostering secure attachment in children and fortifying parent-child relationships.

Research progress of the microbiota-gut-brain axis in autism spectrum disorder and treatment

LING Mei, WANG Yuehong, LI Na, XIONG Yuhong, YANG Shu, XU Guifeng

2025, 33(7):  778-782.  DOI: 10.11852/zgetbjzz2024-1431

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Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder, and its prevalence has shown a sustained upward trend over the past two decades.Emerging evidence suggests a bidirectional regulatory mechanism between ASD-related behavioral manifestations and the microbiota-gut-brain axis (MGB axis), with numerous studies reporting alterations in gut microbiota composition within this axis.This article reviews the therapeutic effects of probiotics, prebiotics, synbiotics, and fecal microbiota transplantation on ASD at varying dosages and treatment durations.Post-intervention assessments using standardized scales, including the Autism Treatment Evaluation Checklist (ATEC), Childhood Autism Rating Scale (CARS), and Autism Behavior Checklist-Japanese Version (ABC-J), demonstrated symptomatic improvements in individuals with ASD.However, all four interventions share limitations, such as a lack of large-scale clinical data and inadequate personalization of dosage and treatment duration to address the heterogeneity of ASD patients.Future research is warranted to validate the efficacy of these microbiota-targeted interventions and optimize treatment protocols for broader clinical application.

Meta Analysis

Bibliometric analysis of global research status and trends of social anxiety in adolescents

NIU Ying, ZHANG Yuqing, LI Yuhan, LIU Zhifen, LI Gaizhi

2025, 33(7):  783-789.  DOI: 10.11852/zgetbjzz2024-0384

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Objective To analyze the current research status of social anxiety in adolescents, and to identify research hotspots and frontiers through CiteSpace, so as to provide insights and references for the direction of scientific research in this field. Methods Relevant literature on social anxiety in adolescents from January 1st, 2003, to December 31st, 2023, was searched in the Web of Science Core Collection (WOSCC). CiteSpace was utilized to conduct co-occurrence, clustering, and burst analysis of authors, countries/regions, and keywords. Results A total of 433 articles were included. Pine Daniel S has published the most articles (15) in the field of social anxiety in adolescents, and the United States ranked first in terms of publication volume (136 articles). Keyword analysis revealed that "comorbidity", "prevalence", "risk factors", "behavioral inhibition", "social skills", "cognitive behavioral therapy", "psychopathology", and "model" were the research hotspots and trends in this field. Conclusions Popular topics in this research field focus on the prevalence, comorbidity, mechanisms of occurrence and development, and treatment of social anxiety in adolescents. Future research should further clarify the etiology of social anxiety in adolescents and explore biomarkers for social anxiety disorder in adolescents using neuroimaging techniques, as well as interventions with better therapeutic effects.

Clinical Research

Efficacy of infra-low frequency transcranial magnetic stimulation on the treatment of autism spectrum disorder combined with sleep disorder in children

LI Nuo, ZHOU Yuan, QIAN Xuguang, LIU Zhenhuan, PANG Bihui, XU Libao, YAO Xiangge, ZHAO Yong

2025, 33(7):  790-795.  DOI: 10.11852/zgetbjzz2024-0862

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Objective To investigate the therapeutic efficacy of infra-low frequency transcranial magnetic stimulation (ILF-TMS) combined with conventional rehabilitation training in children with autism spectrum disorder (ASD) and comorbid sleep disturbances, in order to provide a scientific basis for clinical treatment. Methods A total of 60 children with ASD and sleep disturbances, who were treated at the Nanhai Obstetrics and Gynecology Children′s Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine in 2023, were selected as study participants.They were randomly divided into a study group and a control group using a random number table, with 30 children in each group.The control group received conventional rehabilitation training, including applied behavior analysis therapy, sensory integration training, and speech therapy.The study group received ILF-TMS additionally.Both groups underwent treatment for 12 weeks.The Children′s Sleep Habits Questionnaire (CSHQ), Autism Behavior Checklist (ABC), and Childhood Autism Rating Scale (CARS) were used to assess outcomes before and after treatment.Intra-group comparisons and inter-group comparisons of score changes before and after treatment were conducted to evaluate therapeutic effects. Results In the study group, post-treatment scores for sleep resistance, sleep anxiety, sleep duration, parasomnias, daytime sleepiness, and total CSHQ scores were significantly lower than pre-treatment scores (t=2.438, 2.261, 2.295, 2.987, 5.954, 5.518, P<0.05).Moreover, the differences in the above score changes before and after treatment were significantly greater in the study group compared to the control group, with statistical significance (t=2.201, 2.218, 2.604, 3.322, 6.668, 8.216, P<0.05).Both the study and control groups showed significant reductions in CARS and ABC total scores after treatment (study group: t=3.067, 3.125; control group: t=2.098, 2.094, P<0.05).The difference in ABC total score changes before and after treatment was significantly greater in the study group compared to the control group (t=3.121, P<0.05). Conclusions ILF-TMS can effectively improve sleep disturbances and alleviate clinical symptoms in children with ASD, which provides theoretical support for the application of ILF-TMS in the treatment of children with ASD.

Influencing factors of psychological and behavioral development in 1- to 2-year-old children based on random forest algorithm andmultivariate logistic regression analysis model

QIN Huiling, LUO Yan, ZHU Yan, SHEN Chengwei, JIAN Lanying, TU Kexin

2025, 33(7):  796-800.  DOI: 10.11852/zgetbjzz2024-0578

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Objectives To investigate the current status of psychological and behavioral development in children and its influencing factors, in order to provide a scientific basis for the prevention and control of developmental issues in children. Methods A total of 694 children aged 1 - 2 years who underwent routine health check-ups at the Child Health Care Department of Guiyang Maternal and Child Health Hospital from July 2022 to December 2023 were selected as the study subjects. Their parents were surveyed on general demographic information, screen exposure, and parent-child interaction levels. The Gesell Developmental Scale was used to assess the children′s psychological and behavioral development. The random forest algorithm was employed to rank the importance of influencing factors, and the screened variables were included in a multivariate logistic regression analysis model. Results The ranking of the importance of factors affecting children′s psychological and behavioral development was as follows: birth weight, gender, parity, gestational age, monthly household income, outdoor activities, feeding modes, screen exposure, parent-child interaction, and mode of conception. Multivariate logistic regression analysis revealed that a birth weight ≥2 500g (OR＝0.241, 95%CI: 0.108 - 0.536) and high-quality parent-child interaction (OR＝0.267, 95% CI: 0.122 - 0.585) were protective factors against the risk of delayed psychological and behavioral development in children. Conclusions The psychological and behavioral development of children aged 1 - 2 years still requires significant attention. Therefore, high-quality prenatal management to control neonatal birth weight and the provision of high-quality parent-child interactions by caregivers are essential to promote early childhood development.

Application of child safety seats intervention on children aged 0 - 3 years based on information-motivation-behavior skill model

KOU Zhiru, YUAN Feng, SUN Yaru, XU Xiaohan, YANG Xiuling

2025, 33(7):  801-806.  DOI: 10.11852/zgetbjzz2024-1294

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Objective To explore the effectiveness of a child safety seat (CSS) promotion program based on the Information-Motivation-Behavioral Skills (IMB) model, in order to provide evidence for CSS interventions targeting children aged 0 - 3 years. Methods A total of 110 parents of children aged 0 - 3 years were recruited from the child health clinic of a community health service center in Qingdao from May to July 2024, and were randomly divided into two groups, with 55 participants in each group.The control group received routine child health follow-up, while the intervention group underwent a 4-week IMB model-based CSS health education program.A generalized estimating equation model was used to assess the intervention effects. Results After the intervention, the intervention group showed significant improvements compared to the control group in risk perception-related constructs, including perceived susceptibility (β=-1.15), perceived severity (β=-0.91), self-efficacy (β=-0.89), response efficacy (β =-0.74), and knowledge of CSS type selection (β=-1.28) (P<0.05).Additionally, the intervention group demonstrated higher levels of CSS safety knowledge (β=-2.10), usage motivation (β =-1.48), self-efficacy (β=-1.42), and Objective skills (β=-0.88) (P<0.05), though no significant difference was observed in knowledge about seat replacement (P>0.05).The frequency of risky child passenger behaviors, such as holding a child in arms (OR=0.34) and using a seat belt alone for the child (OR=0.44), decreased significantly in the intervention group (P<0.05), while no significant difference was found in the frequency of children sitting in the front passenger seat (P>0.05).After intervention, the CSS ownership rate (OR=2.89) and usage rate (OR=3.48) were significantly higher in the intervention group than in the control group (P<0.05). Conclusion The IMB model-based CSS intervention can enhance parents′ risk perception and CSS knowledge, reduce risky child passenger behaviors, and increase CSS ownership and usage.

Health Education

Intervention effect of nutrition and health education based on Trans-Theoretical Model of Behavior on the dietary behavior of children with autism spectrum disorder

XU Haiping, DING Dandan, ZHU Yiru, DU Xiaoyan, HUANG Lijie, ZHANG Xueqin, DAI Jingjing

2025, 33(7):  807-812.  DOI: 10.11852/zgetbjzz2024-0531

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Objective To investigate the impact of nutrition health education based on the trans-theoretical model of behavior (TTM)on the eating behavior of children with autism spectrum disorder (ASD), in order to provide a basis for improving the nutritional status and eating behavior of ASD children. Methods Convenience sampling method was used to select the children who were diagnosed with ASD in the Department of Child Developmental Behavior, the Third Affiliated Hospital of Zhengzhou University from March 2023 to June 2023. In order to avoid inter-group contamination, inpatients in the second ward of the Department of Child Developmental Behavior were selected into the intervention group and the inpatients in the first ward of the Department of child developmental behavior were selected as the control group. During hospitalization, the intervention group received nutrition health education based on TTM, while the control group received conventional nutrition health education. Parents′ feeding style and children′s eating behavior were evaluated by feeding style questionnaire and children′s eating behavior questionnaire before intervention and 28 days after intervention. Results After the intervention, the instrumental score, emotional score, and control feeding method score of parents of ASD children in the intervention group decreased (t=4.920, 4.568, 2.476), while the encouraging feeding method score increased (t=4.724), and the difference was statistically significant (P<0.05). Moreover, scores for satiety response, food selectivity, food reaction, decreased emotional eating, excessive emotional eating, and the total score for children′s eating behavior decreased after the intervention in ASD children in the intervention group (t=2.947, 6.139, 2.718, 5.559, 5.331, 3.915, respectively), while the score for food enjoyment increased (t=3.579), with statistically significant differences (P<0.05). Conclusion The implementation of nutrition and health education based on TTM can improve parents′ feeding patterns, reduce the dietary behavior problems of ASD children, and promote their nutritional health of ASD children.